Autism: The Integration Deficit Disorder

by Siegfried Othmer | September 29th, 2006

The story on autism is at once highly promising and depressingly grim. The promising part is that the condition is coming to be understood and so remedies are forthcoming. The grim part has to do with the recognition that this is entirely a man-caused disease. Nature did not conspire against our children in this case. We did so inadvertently, but the mistakes we made are being propagated forward by default and also by design. And therein lies the scandal. We can lay the blame for continuing autism epidemic at the feet of the Centers for Disease Control, of the Food and Drug Administration, of the National Institutes of Health, and of Big PhRMA. Even the Environmental Protection Agency does not entirely escape blame.

Some decades ago an autistic child was brought to the Harvard Medical School and the Chair summoned the class of medical students and urged them all to become acquainted with this case. He said to them: “You may never have a chance to see another case like this in your entire career.” Decades later, the incidence of autism in male children has risen to 1% in this country, and a recent paper in the premier Journal Lancet reported incidence to be 2% among boys in Great Britain. That’s the country that tried to discredit Roger Wakefield, MD for suggesting that the country’s vaccination policy was a contributing cause in the epidemic.

Right now autism looks like a very complex disease, but at least it is now clear that it is in fact a medical disease and not just a genetically caused mental disorder. But if autism is looked at as a disease, it must also be acknowledged that diseases in general tend to look complex only when they are not yet understood. If one looked at diabetes, for example, without knowing that insulin was involved as the key player, it would also look exceedingly complex indeed.

So more than likely it is merely the expression of the disease process in the body and mind that is complex in autism. The underlying disease causative agent may be simple. It is mercury. We have been poisoning our children with mercury. We have done it deliberately; we have done our best to exonerate the practice in the face of damning evidence; and we are continuing to do it. This may turn out to be the most egregious medically caused disaster in the history of medicine, worse than when surgeons failed to wash their hands prior to surgery and as many as ten percent of women in childbirth died at their hands of childbed fever in certain hospitals.

And what has been the response? Drug companies are doing their best to insulate themselves legally from the coming liability storm through their hired guns in state legislatures. At the same time, studies that could fill in the blanks on this hypothesis, such as studying those children who have not been exposed to mercury in vaccines as a comparison group, are not being undertaken.

Mercury is the most toxic element in the periodic table, outside of the radioactive elements like plutonium. It is used as a preservative in vaccines for precisely this reason. Mercury is hostile to life itself. The reader may have been under the impression that Thimerosal was being removed from vaccines for children. Look again. Thimerosal is back in the flu vaccines, and the dose of mercury contained in them exceeds our EPA exposure limits for body sizes less than that of Shaquille O’Neill. Yet infants are given the same size dose as O’Neill.

Recently, a drug trial in the U.K. caused illness within 90 minutes among all six participants. Attention was immediately drawn to the test, and in retrospect the experimental design was labeled “botched.” But what if the adverse response occurred only in a certain genetically vulnerable subgroup, at a rate of perhaps one in a thousand? The effect might not have been noticed at this point, and perhaps not even as larger trials were conducted.

And what if the vaccines to which children were exposed turned out to be quite safe when tested individually at the outset? And then thimerosal was added later when vaccines were combined into multiple doses. And then the vaccination schedule was majorly accelerated for infants, thus compounding the problem. And what if not everyone were vulnerable to the same degree? One could end up with a problem that was not apparent at each step along the way. Do we not then have an innocent explanation of how we got to this point?

Actually not. After all, it has been assumed all along that autism has a genetic component. That assumption alone invalidates all epidemiological studies of thimerosal toxicity effects based on whole populations (that is to say, under the assumption that the population is homogeneous in terms of susceptibility to mercury toxicity). We might have one reaction if we were told as parents, “there is a part in ten-thousand risk of a functional impact” on a child given this vaccine. We might have quite a different reaction if we were told, “there is a ten percent risk of functional impact” of this vaccine in a vulnerable population. We would then clearly want to know if our child is in that vulnerable population. We are having that same discussion now with regard to certain genetic pre-dispositions to breast cancer. This is something that one can explain to a ten-year-old. How is it that the CDC has a problem understanding this?

Believe it or not, one member of this medical conspiracy actually verbalized the question somewhat as follows, “If thimerosal is a problem, why then isn’t everyone that gets it becoming autistic?” People with an MD cannot be that naïve. It is just not conceivable. One must suspect something worse. They are being deliberately obfuscatory.

Having fingered mercury toxicity as the problem (the evidence is available with help from your trusty servant named Google), we must hasten immediately to enlarge our horizon. Just as a child may tolerate an individual dose of vaccine and still succumb to the cumulative impact of many such doses over the first couple of years of life, so it is with mercury in general. It may be the tall pole in the tent when it comes to heavy metal toxicity, but it does not stand alone as a culprit, and vaccines do not stand alone either. The FDA failed to warn pregnant women in a timely manner about mercury in tuna fish, so a particular infant may already be starting out life with a toxic body burden of mercury because its mother thought she was doing a good thing by eating lots of fish. And a variety of heavy metals are becoming problems to our immune system integrity, not just mercury.

So the mercury-laced vaccines may serve simply as “the straw that breaks the camel’s back” at the end of an accumulation of environmental insults to our biological system. This needs to be understood in big-picture sense, and that is not what research does well at all. Such studies need to be quite large to cover all the relevant variables; they need to extend over a long period of time; and they need to have participants that are exceedingly well characterized. This is hugely expensive. Absent such large-scale studies, there is lots of opportunity for the experts to fuzz up the evidence and render it innocuous if they so choose. In the face of complexity, the conspirators can win by mere indirection, by making it appear as if we were looking for one particular blotch in a huge Jackson Pollock painting.

Why is the recitation and recognition of this wretched history important? As long as our medical and governmental leadership is in denial about the underlying problem, it cannot marshal its resources for a remedy. Meanwhile, the emergency of autism is at knocking at our door, one family at a time. It is obvious that a medical disease requires a medical remedy, and lots of these have been proposed and are in the process of being implemented. Each of these techniques targets one or another aspect of the condition. An essential feature of all such approaches is that the outcome is characterized by wide variation over the autistic population. Some children benefit in a major way from one or another of these approaches, others hardly at all. We understand this in terms of a network model of regulatory function. Regulation must be seen as a multiply-connected web, not as a chain. When links in our regulatory regime are degraded, function typically degrades incrementally rather than catastrophically. Similarly, when regulation is restored, function improves incrementally in most cases, although the more isolated dramatic improvements get our attention and convince us that we are on the right track.

With our biomedical approaches, we may have to pursue quite a number of pathways to the restoration of healthy function. All these take time, and they may even have to be properly sequenced. Most are expensive and portend a huge burden on the family. Still, we have to consider ourselves fortunate that we now have a number of techniques that can tackle autism in a kind of pincer movement: biomedical approaches can be seen as “bottom-up” attempts to restore healthy regulation, and the behavioral approaches to autism can be seen as “top-down” methods of restoring function. One targets causal factors, the other the behavioral consequences.

We now have a third major approach that fits somewhere in the middle. It is neurofeedback, and it targets regulation directly. Whereas the behavioral methods do in time achieve adaptations at the brain level, they do so indirectly. And the biomedical approaches are largely judged on the basis of how they impinge on brain function. The action is again somewhat indirect. With neurofeedback we are targeting regulation directly. Neurofeedback is basically a behavioral technique, but the brain is seen as the behaving entity rather than the child. So we have advanced from a pincer movement against autism to Chinese fingers–a three-armed attack.

Just as we try to hone the child’s behavioral repertoire with behavior-shaping techniques, we can try to hone the brain’s behavior at the EEG level. We watch the neuronal dance and we shape its behavior toward better function. So even though we know that the “real” problem has its origin in our physiology, we can still affect the functional impact by direct brain training. In this approach, we take advantage of the fact that we all have considerable functional plasticity available in our brains, and that holds true even for the autistic child.

Moreover, even if the “problem” in autism may have started out with a mercury insult, it then metastasizes (in the poetic sense of that word) and becomes an issue in many regulatory systems. So at some point, even if the mercury were to be removed from the body we would still contend with lingering functional deficits. The disregulation will have been encoded in the cerebral networks, among others, and these will just have to be retrained.

We have recently made some significant breakthroughs in restoring function in autistic children with neurofeedback, and we are aware of similar progress being made in other clinics with a variety of neurofeedback techniques. Also, university-based research has begun on neurofeedback in application to the autistic spectrum. The intent here is not to dwell on these results–exciting as they are–in this article. Rather, we want to point out an emerging set of converging evidence in order to illuminate what is going on more at the conceptual level.

Increasingly we are hearing reports of good results in functional recovery being obtained with hyperbaric oxygen therapy (HBOT). As the data started piling up on this emerging technique, it was shown that benefits could even be derived with modest over-pressure of 1.3 atmospheres, rather than with the 2 atmospheres or more than are used with wound healing and recovery from brain injury. Most recently, we are hearing of gains being achieved even in regular pressurized air, rather than with the use of oxygen under pressure. This makes the technique categorically safe and accessible to the individual clinician. It is even accessible for home use.

There is a third technique that needs to be mentioned in this regard, and it is called “Hemoencephalography,” or HEG. This refers to a biofeedback technique in which the brain is rewarded for enhanced oxygenation or for enhanced cortical temperature. In either of these implementations, this technique can be seen as activating the frontal lobe of the brain. And both show nice functional gains in most autistic children with a modest number of training sessions.

In fact, the functional gains shown by each of these techniques falls into the range of 1-3% improvement in symptom expression per session over the first twenty to forty sessions. The gains start out at the higher end of the range, and then end up at the lower end. These sessions can be spaced as little as a day apart, so we have here three options by means of which parents can get quick help for their child and indirectly also for the whole family.

We know of no other approaches for which gains can be so systematically projected as with these. So parents might very well want to put one of these techniques high on their priority list, even in the knowledge that the biomedical approaches should not be given short shrift–not even if the activation procedures are wildly successful. This presents a real dilemma for parents because many of the biomedical methods–such as the gluten-free and casein-free diets–are rather burdensome to pursue. But we see no alternative.

This also speaks to the broad gray area in which siblings (and the parents who read this) may not be overtly autistic, but with shared genetic endowment may still be functioning below the level of which their systems are capable. The autistic children in this sense are our species’ canaries, the most genetically vulnerable cohort to certain environmental insults that none of us can evade and to which none of us is immune. Those who share common genetics with the autistic child might do well also to consider cleaning up their lifestyle as well as doing neurofeedback.

The common element among all three approaches (HBOT, HEG, and EEG Neurofeedback) is that they serve to activate the brain in general, and the frontal lobe in particular. But then each of the techniques also has its particularities. Neurofeedback can be done in a manner that is highly targeted toward specific functional deficits, such as emotional connection to others, the capacity for communication, speech articulation, sensory excitability, motor function, etc. HEG can also be locally targeted, but it tends to be more oriented toward pre-frontal brain activation generally. Hyperbaric oxygen can best be understood in terms of activation of neural circuitry, but the temporarily heightened oxygen level in the tissues may also have some direct beneficial biological effects.

This is a matter of some controversy because one of the identified hazards in autism is oxidative stress, for which anti-oxidants need to be provided. What sense does it make to supply excess oxygen to such a system? It would probably not make sense at all in the steady state, but as a transient procedure it might very well be helpful. The transient flood of oxygen into the tissues may allow the engagement and activation of neural circuitry that then remains accessible and engaged even after normal oxygenation levels return.

So we can think of each of these approaches as providing the common element of an activation procedure, and then there are also aspects that differentiate between them. These techniques can also be combined, and this is a research goal for the future. A child in a hyperbaric chamber may present a neurofeedback training opportunity beyond what is usually available. Or EEG neurofeedback can be used to follow up on a “priming” session with HEG neurofeedback. Alternatively the child might be asked to enhance the HEG signal while in the hyperbaric chamber in order to derive the maximum benefit.

On the other hand, it may turn out that we should enhance brain activation as much as possible without resort to the delivery of excess oxygen, and to limit the exposure to the latter only to the duration necessary to derive whatever specific benefits are in store. All this is speculation at this point.

One can also envision a hierarchy of approaches in which one moves gradually from the less demanding to the more demanding ones. One starts with HEG training to “prime the pump” and one moves on to EEG neurofeedback. This HEG training can be administered trivially in the home on a daily basis, complemented by EEG neurofeedback done under in a clinical setting at a rate of one to five sessions per week. The two techniques support and complement each other. Improved regulation ensues, and the whole physiology functions with more integrity because the brain is also involved in the regulation of visceral function.

Then, as the benefits of HEG plus EEG neurofeedback begin to plateau, one adds in the hyperbaric oxygen to see if there is further incremental benefit. If so, then one moves on to combine hyperbaric with EEG training in situ for yet greater gains. The EEG or HEG training instrument can be taken right into the chamber without difficulty. Finally, the parents are instructed in home-use EEG neurofeedback for long-term enhancement of brain function. Biochemical approaches are used in addition to achieve new milestones in functionality.

In sum, then, we are at the threshold of a very positive future for autistic children. The watchword always needs to be “progress, not perfection.” We never know how far these techniques will take us with a particular child. But at every level of a child’s function, we know that substantial gains are within our reach. Under the prevailing conditions alluded to above, the whole approach to the autism spectrum has a bewildering and almost over-whelming complexity at the moment. It cannot be otherwise. Even worse, as long as the government agencies are tethered to the assumption that mercury is not the issue, they cannot lead the charge toward an understanding of the remedies, as already suggested.

This has left autism recovery to various brilliant and inventive scientists, researchers, and practitioners out in the field. A substantial body of knowledge has already been accumulated over the last decade, under the leadership of organizations such as Defeat Autism Now. It is not a criticism to point out that most such researchers are narrowly focused on their particular remedy. That being the case, an integrative perspective is still missing. One could even say that the treatment regime for the autism spectrum exhibits some autistic features! Hence parents are left with the unenviable role of sorting all this out and prioritizing remedies for their child. We have no choice. It is premature to be authoritative about what is to be done in a particular case and in what order, although initial attempts are being made now along those lines. So for the time being the decision-making of necessity falls largely to parents.

Ironically, it is the integrative perspective that is also missing within the autistic child. Neurofeedback intrinsically addresses itself to communication relationships within the neuronal networks, so it directly targets what may be the key functional deficit in autism at the brain level. Within the treatment community, neurofeedback may similarly provide a missing perspective on the deficits of functional integration and provide the needed conceptual linkage between the biomedical and the behavioral remedies. Both at the level of the child and at the level of the treatment community, neurofeedback may provide the answer to the observed “Integration Deficit Disorder.”

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